University of Wisconsin–Madison

UW-CTRI Outreach Team Takes Quit Line eReferral to Health Systems

UW-CTRI Outreach
From left: Regional Outreach Specialist (ROS) Alex Peeters, Quit Line Coordinator Kate Kobinsky, ROS Amy Skora, ROS Allie Gorrilla, Outreach Director Rob Adsit and Senior ROS Roger Dier gathered at a state conference. The four ROS are working with health systems to integrate e-referrals to the Quit Line via electronic health records.

UW-CTRI’s four regional outreach specialists are working to expand the number of health-care systems across the state that refer patients via electronic health records (EHR) to the Wisconsin Tobacco Quit Line.

This builds on several partnerships with Epic and other health systems to build eReferral into EHR so doctors can efficiently refer a patient who uses tobacco products to the Quit Line.

For example, UW-CTRI Senior Outreach Specialist Roger Dier is working with ThedaCare in northeast Wisconsin to bring eReferral to that health system. As Dier trained Thedacare clinicians throughout the past year, he cultivated relationships. As a result, Thedacare assigned an IT staff member to their eReferral project.

“Most organizations assign priorities to projects, and eReferral now has a place in line within the ThedaCare organization,” Dier said.

Elsewhere, UW-CTRI partnered with Ascension-Wheaton Franciscan Healthcare and Gundersen Health System on a clinical trial to test eReferrals versus fax referrals. The trial, known as the Quit Line Referral Method Study, included 23 clinics, a dozen from Wheaton Franciscan Healthcare and 11 from Gundersen Health System. In each system, half of the clinics tested the closed-loop, HIPAA-compliant eReferral to the Quit Line via EHR, while the others operated the Fax to Quit program.

Across both healthcare systems, eReferral produced referral rates that were 3-4 times higher than those produced by Fax to Quit. While the rates improved, challenges include increasing enrollment rates as well as sustaining use outside of a research study.

“Gundersen Health System has finished the eReferral research study with us,” said UW-CTRI Regional Outreach Specialist Amy Skora, who works out of Madison and assists southwestern Wisconsin. Skora said UW-CTRI staff have recently written a manuscript summarizing this work.

“Gundersen is planning for a staggered roll-out of the eReferral functionality in their Wisconsin-based outpatient clinics starting in early 2019,” she said. “I will be assisting in training the nine Gundersen clinics in my region.”

Many Gundersen Health System clinics are in western Wisconsin. UW-CTRI Regional Outreach Specialist Alex Peeters serves that part of the state from her office in Eau Claire. “Gundersen is working on scheduling the eReferral trainings currently to roll out the program system-wide,” said Peeters. The first training is scheduled for January 2019.

Ascension-Wheaton Franciscan Healthcare has approved rolling out eReferral in outpatient, inpatient, and specialty care. Regional Outreach Specialist Allison Gorrilla, who works out of Milwaukee and serves southeastern Wisconsin, will help train their staff for implementation.

Meanwhile, UW Health outpatient clinics have been using eReferral since May 2017.

“They have more than 40 clinics/departments active with eReferral and are referring several dozen patients a month,” said UW-CTRI Outreach Specialist Amy Skora.

UW-CTRI regional outreach mapUW Health also began piloting eReferral on a few hospital medicine units in June 2018. The hospital pharmacists provide a tobacco-treatment intervention to all inpatients who smoke. The program emphasizes an opt-out approach to provide treatment to patients unless they decline. In addition to providing eReferral to the Quit Line, the tobacco intervention also meets the Joint Commission’s Tobacco Treatment Measures to screen all patients for tobacco use at admission, provide counseling and nicotine-replacement medications during the hospital stay, prescribe medication when the patient is discharged, and use eReferral at discharge.

“UW Hospital/Pharmacy will be collecting demographic data from Epic, conducting interviews with pharmacists at 30- and 60-days post-pilot launch, and collecting feedback throughout the pilot,” Skora said. “We hope to begin spreading eReferral hospital-wide in early 2019.”

In addition, the Aurora Health Care system spans eastern Wisconsin and has the largest number of clinics participating in Fax to Quit in Wisconsin. “They have been interested in an electronic, closed-loop, EHR-based method of referral to the Quit Line since 2012,” said Gorrilla. “So when Roger and I approached them with a proposal to bring eReferral to Aurora Health Care, they were very interested in hearing more and meeting with us. Roger and I met with their quality improvement manager and director of Aurora network medical operations back in May. In July, Aurora leadership shared our information on eReferral with an Epic Alerts management committee and are now waiting on approval from IT to assign a project manager to oversee the build.”

The outreach specialists are working carefully to make steady progress, but also to not overwhelm the Quit Line by having all health systems start using eReferral at once, said UW-CTRI Outreach Director Rob Adsit. See the map for the health systems in each outreach region.

“It’s one thing to have cessation treatments that work,” said UW-CTRI Director Dr. Michael Fiore. “It’s another to implement them broadly in an efficient manner that is sensitive to the workflows of health systems. That’s why the work of our outreach team is so vital and truly unique.”